Saturday, September 01, 2012

What is chronic pain?

Chronic pain is pain that does not go away. When pain lasts longer than 3 or 6 months, or beyond the usual time for recovery, it is said to be chronic. There are different types of chronic pain, many of which are not clearly understood. Chronic pain may be associated with an illness or disability, such as cancer, arthritis, or a phantom limb. Some types of pain start after an injury or accident and become chronic over time.

Others may begin gradually, as is sometimes the case with low back pain. In some types of chronic pain, like migraine headaches, the pain is recurrent, rather than constant. There are many other kinds of chronic pain, such as postsurgical pain, fibromyalgia, temporomandibular disorders, and neuropathic pain. In some cases, the cause of chronic pain is known, whereas in many other cases it is not.

It is estimated that between 10% and 30% of Canadians experience chronic pain. The direct and indirect costs associated with chronic pain are staggering and they are estimated to be in the billions of dollars annually. Chronic pain affects both sexes, however, the rates are slightly higher in women. Although chronic pain can occur at any age, it is most common in middle age (for additional information about pain in the elderly see the CPA Chronic Pain among Seniors fact sheet).

Chronic pain can make simple movements hurt, disrupt sleep, and reduce energy. It can impair work, social, recreational, and household activities. People who have been injured in accidents may develop anxiety symptoms in addition to pain. Chronic pain can have a negative impact on financial security and in some cases it can contribute to alcohol or drug abuse. It can also disrupt marital and family relationships.

Medications are one of the most common ways to treat pain. Indeed, medications can be helpful in managing chronic pain, however, the suitability of long-term medication use needs to be carefully considered.

Pain is invisible. This can lead people who experience chronic pain to feel misunderstood or alone in their suffering. Some people find that the legitimacy of their pain is questioned. Other people believe that pain is "all in the head". Pain is indeed all in the head because the brain is very actively involved in this experience. Also, what happens in one's mind is inherently tied to what happens in one's body. Given the impact pain can have on quality of life and other life domains, it is not surprising that more than a quarter of people who experience chronic pain also experience significant depression or anxiety.

How can a psychologist help a person with chronic pain?

Psychologist are involved in many aspects of chronic pain, including treatment/clinical work, research, and teaching. In terms of treatment, psychologists use several different techniques to help people with chronic pain improve their quality of life, regain their sense of purpose, and recover their strength.

They also focus on important themes such as acceptance. Specific techniques to help people with chronic pain include support, education, and skill building in areas such as relaxation, biofeedback, stress management, problem solving, goal setting, sleep hygiene, and assertiveness.

Cognitive behavioural therapy (CBT) is an approach that focuses on thoughts, feelings, and actions. It aims to help people think and behave in more adaptive ways. Acceptance and commitment therapy (ACT) is another psychological approach that focuses on acceptance, choice, and taking action. It aims to help people live in ways that are consistent with their values. The basic goal of both approaches is to help people better manage chronic pain and live meaningfully, as opposed to eliminating pain symptoms.

Vocational assessment examines a person's interests, aptitudes, and abilities. It is useful for individuals who may need to change the way in which they work, or the kind of work they do, because of pain.

Psychotherapy for anxiety and/or depression can be very helpful for individuals experiencing chronic pain. When indicated, treatment for drug or alcohol abuse helps people deal with addiction. For people who find that chronic pain has affected their personal relationships, couple/marital or family therapy is often recommended.

Are psychological approaches effective?

Psychological approaches have been shown, in numerous studies, to help people with chronic pain improve the quality of their lives. In particular, they are known to increase functioning in many life domains, such as activities of daily living, emotional health, and interpersonal relationships, and result in decreased pain symptoms. Following psychological treatment, people report that they are more active, less depressed, less anxious, and more in control. Even though people continue to experience chronic pain, it is more manageable.

Although individual therapy may be offered, people experiencing chronic pain are often treated in groups where they are able to share their experiences with others who live with pain.

Because chronic pain is complex, psychologists often work in interdisciplinary or multidisciplinary teams with other health care professionals, such as physiotherapists, occupational therapists, physicians, nurses, social workers, and pharmacists to help people with chronic pain develop satisfying and healthy lifestyles.

Interdisciplinary chronic pain rehabilitation programs are as effective in reducing pain intensity as medications and medical interventions, however, they are more effective in decreasing medication use, reducing health care utilization, improving functional activities, improving mood, and promoting return to work.

If they can put a man on the moon and replace a heart, why can't they get rid of my pain?

In addition to working directly with people who have chronic pain, psychologists have contributed significantly to our understanding of chronic pain through many kinds of research. Clinical research is often conducted by psychologists in collaboration with organizations and workers in an attempt to reduce the incidence of some types of chronic pain, either through injury prevention or early intervention programs. Clinical research conducted with people experiencing chronic pain has helped develop effective management approaches.